Hillsborough High’s Terrence Mitchell is knocked out during a game. He got the green light to play three weeks later.

TAMPA — Throughout his football career, former Pasco High School quarterback Ben Alford played through broken fingers and torn hip flexors. Pain was just a part of the game, so a headache was never enough to keep him off the field.

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A year ago, at the age of 24, Alford, who played professional indoor football, was forced to walk away from the game. Not because of damaged joints and bones, but because one more hit to the head could have been devastating.

Alford, a first-year head football coach at Wesley Chapel High, had 15 concussions in 17 years playing football. He said about 10 occurred during his youth football and high school days. After his last one, sustained while playing with the Iowa Blackhawks of the American Professional Football League, he realized he had to leave the field. A CAT scan revealed the hit that ended his career was dangerously close to his brain stem.

"The doctor said that one more shot and I could be a vegetable," Alford said. "It's a tough thing. You never think about all that when you're playing. Football is a contact sport. Getting hit is a part of it. I've always had a passion for football, so I always wanted to be on the field to help my team."

About 300,000 kids, and one in every four athletes 18 or younger, suffer some form of concussion, said Dr. Eric Coris, the head medical team physician for USF athletics and a member of the university's new concussion center.

But Coris said those numbers are low because they include only reported cases. Many times an athlete doesn't lose consciousness when sustaining a concussion.

"I would say that one in every two kids, if not every kid, has suffered some type of mild concussion," Coris said. "Some are mild; all are not life-threatening. Unfortunately, I don't think we realize yet the kind of public health burden this truly is."

Alford said doctors have told him the number of concussions he has had make him susceptible to Alzheimer's disease and dementia when he gets older.

In May, NFL commissioner Roger Goodell issued a letter to state governors, including Florida, urging them to adopt better laws to protect young athletes.

Goodell cited the recently passed Lystedt law in Washington, named after Zackery Lystedt, now 17, who in 2006 suffered a severe brain injury after returning to a football game too soon after taking a hit. The crux of the law is that any player suspected of having a concussion must immediately be taken out of a game or practice and cannot return until cleared by a licensed health care professional.

There are an additional 29 states, including Florida, that have Zackery Lystedt Brain Project coalitions working toward legislation.

Gov. Charlie Crist campaigned for nationwide concussion regulation during Super Bowl week in February, and Florida is planning to introduce legislation on the issue when the legislature regularly assembles again in March, said Jennipher Dickens, spokeswoman for the Zackery Lystedt Project.

Getting back in the game too soon

According to a study conducted last year by the Center for Injury Research and Policy at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, at least four of every 10 high school athletes who have concussions return to action too early.

Hillsborough County athletic director Lanness Robinson said there is no athletic policy regarding an athlete returning to play after an injury, but district policy says medical clearance is needed before participating in school-related activities. Pinellas County public schools have a rule that says a coach must receive a written doctor's release.

Returning to play before giving the brain enough time to heal can leave athletes susceptible to second-impact syndrome, resulting in severe brain swelling and damage. Sometimes the hit that causes second-impact syndrome isn't a hard one.

"You never think of second-impact syndrome," said Alford, who missed just two games in his career because of concussions. "I'd have headaches. I'd feel sick to my stomach. I had mood swings. I'd be yelling at my coach one minute and then apologizing the next. You'd be depressed one moment and be happy the next.

"You just always wanted to be out there. It's a sad thing to say, but if I didn't have a wife and two kids, I'd probably still be trying to play."

Two years ago, Hillsborough High's football player and current USF freshman cornerback Terrence Mitchell sustained a scary concussion during his junior season. While making a tackle against Plant, Mitchell lost consciousness and was carted off the field. It was his third concussion.

For Terriers coach Earl Garcia, deciding when to allow Mitchell back on the field was difficult. After a doctor's clearance, Mitchell returned against Tampa Bay Tech three weeks later. But Garcia removed him from the game because "he just didn't seem right."

"At the high school level, we just don't have the kind of technology that the NFL or even colleges have," Garcia said. "It's still a calculated guess. It's not like a broken leg. You know when it's healed. … The next Thursday, Terrence told me he was fine, but anything having to do with the heart or the head you don't want to mess with."

Help is on site, but education is key

Pinellas County athletic director Nick Grasso said each of the county's 16 public schools has licensed athletic trainers on site for practices and games who give the final say — even over coaches — on whether an athlete is fit to return to a game.

Of Hillsborough County's 27 high schools, half have certified athletic trainers, Robinson said, and all come to them at no cost through partnerships with USF and Florida Orthopedic.

"We're lucky to have what we get," Robinson said. "We need more qualified people to deal with the issue. To have more people, we need to pay them. To pay them, we need money."

Still, there's nothing to say a specific kind of doctor or testing has to be done — whether an athlete needs to see a neurologist or must have a CAT scan.

Tampa Bay Youth Football League president Scott Levinson said coaches stress the safe way of hitting and the league makes sure equipment is safe — helmets are tested every two years. Medical personnel are on hand at every game.

"I think as a youth league we go above and beyond," said Levinson, who suffered a concussion in the ninth grade. "Could we do more? I don't know. There are new helmets, new technology. But that's expensive."

Coris said the key is educating players, parents and coaches on the importance of recognizing symptoms, making sure players are symptom-free before they return and monitoring players to make sure symptoms don't return.

"The more we can raise awareness and get the word out, the better we are," Coris said. "It's an education issue. Most coaches mean well. A lot of them at the youth level are dads or former players. They have incomplete concussion information.

"I would just always say, don't underestimate any concussion."

FAST FACTS

Playing it safe with concussions

While a concussion is commonly thought of as losing consciousness, many occur without being knocked out. From the National Federation of High Schools, common signs of a concussion:

• headaches

• fogginess

• difficulty concentrating

• easily confused

• slowed thought process

• difficulty with memory

• nausea

• lack of energy, tiredness

• dizziness, poor balance

• blurred vision

• sensitive to light and sounds

• mood changes; irritable, anxious or tearful

Suggested concussion management

1. No athlete should return to play on same day of a concussion.

2. Any athlete suspected of having a concussion should be evaluated by an appropriate health care professional that day.

3. Any athlete with a concussion should be medically cleared by an appropriate health care professional before resuming participation in practice or competition.

4. After medical clearance, return to play should follow a protocol with provisions for delayed return to play based upon return of any signs or symptoms.